Individual
VICTORIA NORTHUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Mailing address
8326 S DURHAM ST APT E311, SANDY, UT 84070-1263
(301) 448-0445
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
A0689
MD
103T00000X
Psychologist
A0689
MD
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/22/2021
Last updated
06/27/2023
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